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You may have heard of the abortion pill, which is actually a two-medication process using mifepristone and misoprostol. Together, these FDA-approved pills are up to 98 percent effective and are very safe.
But there's another option that's been used safely around the world for decades: misoprostol alone. Misoprostol-only abortion care is a safe and effective option that has been endorsed by the World Health Organization, the Society of Family Planning, the National Abortion Federation, and other leading medical organizations.
What is misoprostol?
Misoprostol is a medication that causes the uterus to contract. It was originally developed to treat stomach ulcers. Since then, it's been used in reproductive health care for decades—including for medication abortion, managing miscarriage, and inducing labor.
For abortion, misoprostol triggers the cramping and bleeding that empties the uterus. It comes in four pills (800 mcg total) taken three ways: between the gums and cheeks (buccally), under the tongue (sublingually), or vaginally.
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What is a misoprostol-only abortion?
While a medication abortion is typically a two medication process, a misoprostol-only abortion skips mifepristone. Instead of one dose of misoprostol, you take multiple doses spaced three hours apart—the additional doses make up for not using mifepristone.
Misoprostol-only has been a standard option globally for decades, particularly where mifepristone isn't approved or available.
Why someone might have a misoprostol-only abortion:
There are many reasons why someone may not use mifepristone for their abortion, including:
- Mifepristone isn't available at their pharmacy or through their provider
- Laws restrict access to mifepristone specifically
- Cost or insurance coverage makes mifepristone inaccessible
- Allergy to mifepristone
- Taking medications that don’t interact well with mifepristone
How does it work?
Misoprostol helps the uterus to contract, causing cramping and bleeding to empty the uterus and end a pregnancy. Taking multiple doses increases that effect, which is why the misoprostol-only protocol uses three to four doses instead of the single dose used when mifepristone is also prescribed.
WHO guidelines state that misoprostol-only abortion care is effective up to 12 weeks from the first day of your last menstrual period.
How effective is a misoprostol-only abortion?
- 93% complete abortion without additional treatment (3–4 dose protocol)5
- 3–6% of people have an ongoing pregnancy requiring follow-up care5
- <1% hospitalization or transfusion rate across clinical studies5
Using a 3–4 dose protocol, a misoprostol-only abortion ends about 93% of pregnancies on its own.5 That's somewhat lower than the combination regimen of mifepristone and misoprostol (which is up to 98% effective), which is why the combination of the two medications is still the gold standard when both medications are available. But for the millions of people globally for whom mifepristone isn't an option, misoprostol-only is a proven, effective alternative.
Is a misoprostol-only abortion safe?
Yes. A misoprostol-only abortion has a strong safety record. Across dozens of clinical studies involving thousands of patients, serious complications—including hospitalization or transfusion—occurred in less than 1% of cases.5
The safety profile of a misoprostol-only abortion is consistent with the combination regimen of mifepristone and misoprostol.
Who shouldn't use misoprostol-only for their abortion
A small number of medical situations make a misoprostol-only abortion unsuitable. Your Hey Jane provider will screen for these before prescribing:
- IUD currently in place (can be removed before starting)
- Suspected or confirmed ectopic pregnancy
- Allergy to misoprostol or other prostaglandins
- A bleeding disorder or blood-thinning medication (other than aspirin)
Misoprostol-only vs. mifepristone + misoprostol: Key differences
Both are safe, both are effective, and both are real options. Here's how they compare:
Where can you get misoprostol for an abortion?
Telehealth
Telehealth is the most private and convenient way to access misoprostol-only abortion care if you're in a state where it's available. Hey Jane offers medication abortion—including both mifepristone-misoprostol protocols and misoprostol-only protocols—entirely virtually: a video or messaging consultation with a licensed provider, medication shipped directly to your door, and 24/7 clinical support throughout the process.
In-person clinics
Many abortion clinics and reproductive health providers also offer misoprostol-only protocols. If you’re looking for a nearby clinic, we recommend using a trusted directory like Abortion Finder.
Wherever you access care, what matters most is that you're working with a licensed provider who can make sure that care is safe for you, answer your questions, prescribe an appropriate medication regimen, monitor safety and effectiveness, and support you through the process.
Sources:
1 Raymond EG et al. First-trimester medical abortion with mifepristone 200 mg and misoprostol. Contraception. 2013.
2 World Health Organization. Abortion care guideline. WHO; 2022. srhr.org/abortioncare
3 Baum S, Moseson H, et al. Misoprostol Only is Safe and Effective. Society of Family Planning. August 2023.
4 National Abortion Federation. 2024 Clinical Policy Guidelines for Abortion Care.
5 Raymond EG, Mark A, Grossman D, et al. Medication abortion with misoprostol-only: A sample protocol. Contraception. 2023;121:109998.
6 Moseson H, Jayaweera R, Baum SE, Gerdts C. How effective is misoprostol alone for medication abortion? NEJM Evidence. 2024;3(6).
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